Sleep disorders associated with COVID-19 pandemic are termed as ‘COVID-somnia.’ In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms. This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants’ demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model. A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores. Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

Background: In the postacute phase of coronavirus disease-2019 (COVID-19), survivors may have persistent symptoms, lung function abnormalities, and sequelae lesions on thoracic computed tomography (CT). This new entity has been defined as post-COVID interstitial lung disease (ILD) or residual disease. Aims: To evaluate the characteristics, risk factors and clinical significance of post-COVID ILD. Study Design: Multicenter cross-sectional analysis of data from a randomized clinical study. Methods: In this study, patients with persistent respiratory symptoms 3 months after recovery from COVID-19 were evaluated by two pulmonologists and a radiologist. post-COVID ILD was defined as the presence of respiratory symptoms, hypoxemia, restrictive defect on lung function tests, and interstitial changes on follow-up high-resolution computed tomography (HRCT). Results: At the three-month follow-up, 375 patients with post-COVID-19 syndrome were evaluated, and 262 patients were found to have postCOVID ILD. The most prevalent complaints were dyspnea (n = 238, 90.8%), exercise intolerance (n = 166, 63.4%), fatigue (n = 142, 54.2%), and cough (n = 136, 52%). The mean Medical Research Council dyspnea score was 2.1 +/- 0.9, oxygen saturation was 92.2 +/- 5.9%, and 6-minute walking distance was 360 +/- 140 meters. The mean diffusing capacity of the lung for carbon monoxide was 58 +/- 21, and the forced vital capacity was 70% +/- 19%. Ground glass opacities and fibrotic bands were the most common findings on thoracic HRCT. Fibrosis-like lesions such as interlobular septal thickening and traction bronchiectasis were observed in 38.3% and 27.9% of the patients, respectively. No honeycomb cysts were observed. Active smoking [odds ratio (OR), 1.96; 95% confidence interval (CI), 1.44-2.67), intensive care unit admission during the acute phase (OR, 1.46; 95% CI, 1.1-1.95), need for high-flow nasal oxygen (OR, 1.55; 95% CI, 1.42-1.9) or non-invasive ventilation (OR, 1.31; 95% CI, 0.8-2.07), and elevated serum lactate dehydrogenase levels (OR, 1.23; 95% CI 1.18-1.28) were associated with the development of post-COVID ILD. At the 6-month follow-up, the respiratory symptoms and pulmonary functions had improved spontaneously without any specific treatment in 35 patients (13.4%). The radiological interstitial lesions had spontaneously regressed in 54 patients (20.6%). Conclusion: The co-existence of respiratory symptoms, radiological parenchymal lesions, and pulmonary functional abnormalities which suggest a restrictive ventilatory defect should be defined as post-COVID-19 ILD. However, the term "fibrosis" should be used carefully. Active smoking, severe COVID-19, and elevated lactate dehydrogenase level are the main risk factors of this condition. These post-COVID functional and radiological changes could disappear over time in 20% of the patients.

Background: Pulmonary thromboembolism (PTE) is a preventable yet potentially fatal condition with significant morbidity and mortality. Several clinical scoring systems, including the Wells and modified Geneva scores, have been developed to assess the likelihood of PTE and guide further diagnostic evaluation. The Padua prediction score, primarily used to assess venous thromboembolism (VTE) risk in hospitalized patients, has also been considered for its potential utility in suspected PTE cases. Methods: This retrospective study included 257 patients with suspected acute PTE. Diagnosis was confirmed by computed tomography pulmonary angiography (CTPA) in 140 patients (patient group), while 117 patients without radiologic evidence of PTE served as controls. All participants were evaluated using Wells, modified Geneva, and Padua scores. Sensitivity, specificity, predictive values, and the effect of combining scores with age-adjusted D-dimer levels were analyzed. Results: The Wells score demonstrated a sensitivity of 60% and specificity of 91%, with a positive predictive value of 88%. Modified Geneva and Padua scores showed lower diagnostic accuracy. Negative predictive values increased significantly when combined with age adjusted D-dimer levels. Conclusions: The Wells score was the most reliable tool among the three for predicting PTE. Combining clinical scoring with D-dimer testing enhances diagnostic accuracy and may reduce unnecessary imaging in patients with low to moderate risk.

Background: Early risk assessment in acute pulmonary embolism (PE) remains challenging, particularly in normotensive patients. Lactate may offer incremental prognostic value beyond conventional tools. We investigated the association between arterial lactate and in-hospital mortality in acute PE. Methods: In this retrospective single-center study, 327 adult patients diagnosed with acute PE by computed tomography pulmonary angiography who underwent arterial blood gas analysis within the first six hours of emergency department presentation were included. Patients were categorized according to the occurrence of in-hospital mortality, including 103 (31.5%) non-survivors and 224 (68.5%) survivors, and their demographic, clinical, laboratory, and echocardiographic characteristics were compared accordingly. Results: Arterial lactate levels were significantly higher in non-survivors than survivors [4.1 vs. 1.9 mmol/L; p < 0.001], with a stepwise increase in mortality across lactate categories (4 mmol/L; p < 0.001). In normotensive patients (n = 211), lactate ≥2 mmol/L was associated with higher mortality compared with <2 mmol/L (35.7% vs. 8.7%; OR 5.8, 95% CI 2.7–12.5; p < 0.001). In multivariable logistic regression analysis performed in normotensive patients, arterial lactate level, PESI score, and the presence of cerebrovascular disease were identified as independent predictors of in-hospital mortality, whereas troponin did not retain independent significance. In normotensive patients, lactate showed better discriminative ability than troponin I (AUC 0.718 vs. 0.553). Conclusions: Arterial lactate levels are independently associated with in-hospital mortality in acute PE. Elevated lactate may help identify high-risk patients even in the absence of hypotension and may provide incremental prognostic value beyond existing risk stratification tools. These findings suggest the use of arterial lactate in early risk assessment.

Background: Differentiating exudative from transudative pleural effusions is essential for accurate diagnosis and management. Although Light’s criteria remain the standard diagnostic method, they may incorrectly classify a substantial proportion of transudative effusions as exudates. This study aimed to evaluate the diagnostic performance of pleural fluid cholesterol and compare it with Light’s criteria. Methods: This retrospective study included 751 patients with pleural effusion who underwent diagnostic evaluation between 2015 and 2024 and had a definitive etiological diagnosis. All patients underwent ultrasound-guided thoracentesis with simultaneous pleural fluid and serum biochemical analyses. Based on final etiological diagnosis, effusions were classified as transudative or exudative. Results: The mean age was 68.6 ± 15.8 years. Of the pleural effusions, 516 (68.7%) were exudative and 235 (31.3%) were transudative. Malignant pleural effusion was the most common cause of exudates, whereas congestive heart failure predominated among transudates. Pleural fluid cholesterol levels were significantly higher in exudative than transudative effusions (91.1 ± 30.7 vs. 28.9 ± 13.5 mg/dL, p < 0.001). Receiver operating characteristic (ROC) analysis demonstrated excellent diagnostic performance for pleural fluid cholesterol (AUC = 0.976, 95% CI 0.965–0.987, p < 0.001). A pleural cholesterol cut-off value of ≥50 mg/dL demonstrated 92.2% sensitivity, 94.9% specificity, 97.5% positive predictive value, and 84.8% negative predictive value for identifying exudative effusions. Light’s criteria showed higher sensitivity (99.2%) but lower specificity (84.4%). Light’s criteria misclassified 15.6% of transudative effusions as exudates, whereas pleural cholesterol misclassified only 5.1%. Conclusions: Pleural fluid cholesterol measurement demonstrated high diagnostic accuracy in differentiating exudative and transudative pleural effusions and substantially reduced false exudate classification compared with Light’s criteria. Routine assessment of pleural cholesterol may improve the diagnostic evaluation of pleural effusions.

Background: Community-acquired pneumonia (CAP) is a common infectious disease associated with substantial morbidity and mortality. Acute kidney injury (AKI) is a frequent complication of CAP and may adversely affect clinical outcomes. This study aimed to determine the frequency of AKI and identify factors associated with AKI in hospitalized patients with CAP. Methods: This retrospective cohort study was conducted at a tertiary care university hospital in Türkiye and included patients aged >18 years hospitalized with CAP between July 2024 and July 2025. Only patients initially admitted to the general ward were included. Patients receiving dialysis for end-stage renal disease, those with active malignancy, those receiving immunosuppressive therapy, and those with incomplete data were excluded. Demographic characteristics, vital signs, laboratory findings, comorbidities, smoking status, and medication histories were recorded. AKI was defined according to KDIGO criteria using the closest clinically stable pre-admission serum creatinine value obtained within 7–365 days before hospitalization as baseline. Results: Among 161 patients, AKI was identified in 60 (37.3%), including 43 patients who fulfilled the KDIGO criteria at hospital admission and 17 who developed AKI during hospitalization. Eight patients with AKI (13.3%) required hemodialysis, although none became permanently dialysis-dependent. Patients with AKI had longer hospital stays (p = 0.038) and a greater need for intensive care (p = 0.028). They were older and had higher respiratory rates, blood urea nitrogen (BUN), and red cell distribution width (RDW) values and lower diastolic blood pressure. DM and CKD were more common in the AKI group. In multivariable analysis, confusion (adjusted OR 5.03, 95% CI 1.01–25.02; p = 0.048), CKD (adjusted OR 6.00, 95% CI 1.28–28.13; p = 0.023), and higher BUN levels (adjusted OR 1.095 per 1 mg/dL increase, 95% CI 1.046–1.146; p < 0.001) were independently associated with AKI. These associations were retained in a Firth penalized logistic regression sensitivity analysis. Conclusions: AKI was common among hospitalized patients with CAP and was associated with longer hospital stay and greater intensive care utilization. Confusion, pre-existing CKD, and elevated BUN levels were independently associated with AKI, whereas DM was not independently associated after multivariable adjustment. Given that most AKI cases were already present at hospital admission, these findings should be interpreted as associations rather than predictors of incident AKI.